Thursday, September 3, 2009

Tuesday Miscellany


I almost spent the night in the Global Command Center. I was working on a regulatory landscape, alternating internet searches with cut and paste into a huge spreadsheet, when I heard the downstairs door bang shut. An innocent investigation of the cause revealed that the office staff was closing up the building for the night. It was not a pretty scene: "Meneer, you can't expect that we will remember to look for you! You must be at the door by 5:30 in the future!" I hope that there's never a fire.
Shortly after I arrived in Arnhem, I received a series of increasingly frantic Dutch e-mails one afternoon (you can always tell when the ratio of capital letters to lower-case exceeds 1:1). Not having visited the nuns, I ignored them all. Finally someone wandered in to tell me to evacuate the building: the weather service had warned of 100 km/hr winds and there was fear that the windows wouldn't hold. So I weathered the storm in my car, stuck in traffic along the Neder Rhein.
I'm still not used to the work hours being so fixed and limited here in Europe. If I wandered into the corporate offices late or on the weekend, I would set off the security alarms. If I showed up at 8 am in Arnhem, the coffee wouldn't have started. The Dutch program doesn't simply recommend an 8-hour workday: it actively enforces it. In concept, I do love Europe, but I have to get my habits in sync.
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The health care debate tumbles on in the US, hopefully headed towards a better resolution when Congress comes back in September. I think that Pres Obama has to call a reset to the process: the debate has really degenerated in recent weeks. Legislative sponsors have not handled the criticisms well: when someone says that the death panels will kill their grandmother, their concern can't be dismissed out of hand as ridiculous. If we all agree (and we should) that end of life decisions are personal and family matters, then we should make that explicit in the legislation, confronting the problem head-on.
I think that we have to go back to first principals. We need universal, high-quality health care. There needs to be more emphasis on risk identification and prevention, rather than treatment and rehabilitation. People should pay or be taxed the same for the basic care package, like the Dutch system, and I like having employers (or, for the unemployed, government) provide the basic stipend. People should have free market choice among providers; I don't think a government-run option is needed if there is good insurance reform to eliminate exclusions and to keep basic policy costs within reach. People should have the opportunity to choose specialty a' la cart options, and children should have enhanced coverage to ensure dental care and immunizations.
I don't know how to achieve meaningful cost control: the options I've heard so far like switching to electronic records or limiting legal penalties don't seem like they will save much. More savings might be achieved if we were to get commercial influences out of the standards of care, address high capital and consumable costs of diagnostic systems and prescriptions, and have flexibility in deciding where healthcare gets delivered (hospitals as a last, and temporary, choice).
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I was reflecting on the strengths that we develop as expatriates: it forces us to keep an opportunistic and take-what-comes approach to life, to express ourselves simply and clearly, to become perceptive and flexible problem-solvers, and to have tolerance for alternative perspectives and lifestyles. I think that these are all good traits and necessary, all to some degree, in order to succeed outside of one's home culture and language.
When I visit the US, though, I realize that there is also a downside to these traits. Living opportunistically loses the sense of home and longstanding friendships and traditions. Simple, direct (Dutch) communication styles can seem abrupt and rude. Sometimes flexible problem solving means not taking 'No' for an answer; sometimes tolerance is achieved through detachment. I've noticed a loss of grounding, a contraction to where only the "13 boxes of stuff" have constancy.
I suppose it comes back to being a matter of balance and connection: the importance of taking time out-of-assignment periodically and of not letting people drift out of my life.

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